By JULIE MINDA
Part 3 in a series on the ministry's response to the U.S. obesity epidemic
Many ministry facilities are identifying obesity as a top public health priority and developing programs that resonate in their communities to address it. Providers are partnering with other local organizations to extend their reach into underserved neighborhoods and to pool their expertise and resources. What follows are a few examples of such outreach:
Starting early
In Pueblo, Colo., St. Mary-Corwin Medical Center and group of community partners developed a wellness program for kids aged 8 to 12 who are overweight or obese, and their parents. In the free Smart Moves for Kids program, participants find out which foods are healthy and which are not, they get behavioral health lessons to build their self-esteem and they learn how to have fun exercising. They earn prizes for their efforts.
Michele DesLauriers, St. Mary- Corwin vice president of mission integration, said Smart Moves teaches families health lessons that they can easily incorporate into everyday life. The program aims to make lessons enjoyable, with activities like jump rope, dance and hula hoops. "The kids love it and learn quickly," she said.
During a 10-week Smart Moves pilot session this summer, 16 families enrolled, and 11 completed the course. Health assessments showed that while not everyone achieved hoped-for reductions in body mass index and weight, they did report that, on a daily basis, they were watching less television, exercising more, eating more fruits and vegetables, reducing their consumption of juices and sodas and eating breakfast more often. Most of the children improved their running speed and flexibility, fitness tests showed.
Pueblo resident Janelle Patton and her 10-year-old daughter Morgan took part in Smart Moves on the recommendation of Morgan's pediatrician, who was somewhat concerned about the girl's weight and cholesterol level. Through Smart Moves, mother and daughter learned to read labels to find hidden problem ingredients such as refined white sugar, and they got cooking tips for healthy meals. With Smart Moves over, they've kept in touch with friends they met in the program and have joined some of them for another health program, at the Pueblo YMCA.
In California, St. Joseph Health System hospitals are training general and physical education teachers on how to increase high-intensity physical activity for their students, using curriculum and equipment provided by St. Joseph. Through the program, called Healthy for Life, St. Joseph also helps schools provide popular kickboxing, Zumba and Hip Hop fitness instruction during PE classes.
Program dieticians present on nutrition topics to preschool parents and students in elementary through high school. Healthy for Life also distributes health tips through the schools to students and families. Materials are in both English and Spanish; the schools served by Healthy for Life have a large Latino population. Research shows that Latinos are at greater risk of obesity and its comorbidities than are Caucasians.
Azhar Qureshi, St. Joseph senior vice president for community health, said obesity is a "hard problem to tackle," but Healthy for Life is making headway in teaching kids to make healthy choices.
Provena Saint Joseph Medical Center in Joliet, Ill., is part of a coalition that offers low-income students in Joliet schools free access to after-school and summer health programs. Third-graders learn about nutrition and participate in physical activities at Camp Fitness. Fourth-graders get outdoors and learn about nature through Kids 'n Nature. Fifth-graders participate in swim classes and other recreation at the YMCA.
Julie Edwards, Provena Saint Joseph mission services director, said children have gravitated to the programs because they like to stay active; they just might not know how to be physically active at home. She said community assessments have shown that Joliet has a childhood obesity problem that is due in part to families' lack of easy access to parks and recreation. The health programming teaches kids they don't need access to a gym with expensive equipment to exercise; they can jump rope or race with friends.
Measures show participants have improved their health and their knowledge of how to be healthy, which Edwards said can lead to healthier lifestyles for the whole family.
Adult education
In Chattanooga, Tenn., Memorial Hospital and its partners developed their antiobesity effort using information gained in forums Memorial held in communities with high rates of obesity. The forums revealed that people in those areas have many barriers to weight loss. For example, they often live in neighborhoods where high crime rates make them reluctant to exercise outdoors. They often have few grocery stores nearby, so it's hard to buy fresh fruits and vegetables, explained Elizabeth Jenkins, Memorial's coordinator of healthy communities.
Memorial worked with partner organizations to offer free health classes to adults (a program for children is in pilot phase). Six different 12-week classes are held at three recreation centers. Participants learn about nutrition, exercise and healthy living; they get encouragement from each other; and they get access to the exercise equipment at the rec centers for the duration of the classes, which are called We are Winning at Losing.
Participants have lost an average of 10 pounds. Jenkins said for many participants the benefits go beyond dropped pounds. One woman's weight loss gave her the confidence to pursue a master's degree. Another was able to give up a walking cane, and she no longer requires her husband's help to get in and out of the tub.
Lose to win
SSM Health Care – St. Louis' antiobesity program, called the Lose to Win Challenge, is a 12-week weight loss contest for adults age 18 and over. Community members register for the challenge by phone or online; they get their blood pressure, body mass index and body fat checked at one of the organizations sponsoring the challenge; and they receive free or discounted workout passes. They also get tips on how to lose weight, both from health experts at challenge kick-off events, and at a Lose to Win website.
Each week, challengers weigh in at SSM or a partnering organization, YMCAs and Curves among them. Top losers receive prizes and publicity in a local newspaper.
The contest was so successful in a pilot at SSM DePaul Health Center in suburban St. Louis early this year that this fall SSM broadened its reach to involve all of its St. Louis hospitals and the metropolitan area. More than 1,100 people registered, 860 people started the program, and 80 percent of them completed it. SSM plans to start a new challenge in January.
Jamie Newell, SSM DePaul Health Center communications director, said people like Lose to Win because it does not promote a particular weight loss method — it allows people to choose what works for them. "We are just here to provide support, motivation and accountability" for people, Newell said.
Bonnie Barczykowski, program director for Lose to Win, said many participants signed up for both challenges; many got their friends or family involved. Participants said Lose to Win kick starts healthy lifestyle changes. "It has provided the motivation we had hoped it would," Barczykowski said.
Building momentum
Julie Trocchio is CHA's senior director of community benefit. She said it's important for ministry members to continue to pursue local approaches like these and to share their experiences with one another, so that others can duplicate what works.
Trocchio noted that obesity will continue to be major focus of the nation's public health efforts, given the health risks obesity engenders and health care reform's drive to reduce health care spending through prevention. With the attention ministry providers and others are devoting to the obesity problem, Trocchio said, "I'm optimistic that in time we'll see widespread results."
First Lady, Surgeon General target obesity
Community coalitions aren't the only ones looking at how to address the nation's obesity epidemic. Much is happening at the national level as well. First Lady Michelle Obama and U.S. Surgeon General Regina Benjamin are among those in the nation's capital who are advancing broad, national efforts to curb obesity.
The First Lady launched her Let's Move initiative in early 2010 with the goal of ending childhood obesity in a generation. The effort provides parents with information about healthy choices; asks schools to serve healthier foods; and urges elected officials, health care providers, community organizations, the private sector and others to unite behind creating healthy environments for children.
Among the programs the First Lady has supported through Let's Move are:
- Let's Move Cities, Towns and Counties asks elected officials to push for healthier foods in schools; improved access to affordable, healthy foods in neighborhoods; and increased physical activity across the board.
- Chefs Move to Schools encourages chefs to adopt a school and advise teachers, parents, school nutritionists, administrators and others on how to budget for and serve healthier foods, particularly through the national school lunch program.
- Let's Move Faith and Communities engages faith-based and community organizations in promoting healthy living by establishing farmer's markets or taking on health improvement challenges.
- Let's Move Outside works with the U.S. Department of the Interior to promote outdoor activity for children, through "junior rangers" and other kid-friendly programs.
- Let's Move! Museums and Gardens encourages museums, gardens and zoos to stage healthy living exhibits, events and programs.
- Let's Move! in Indian Country supports tribal leaders of Native American communities in improving access to healthy food and encouraging healthy eating and increased physical activity.
- Let's Move! Child Care encourages child care providers and parents to use a checklist to ensure they are providing nutritious food to children and that they are encouraging physical activity.
- Let's Move! In the Clinic arms health care providers with materials to educate patients and community members about the dangers of obesity and how to address the condition.
Benjamin, who is a former CHA board member, lends her authority as Surgeon General to several federal anti-obesity programs, including an initiative launched in 2007 by the U.S. Department of Health and Human Services to equip parents, caregivers, schools, community leaders and others to help shape children's eating habits in a healthy way. The Surgeon General has been visiting communities that have united behind anti-obesity efforts, and is urging other communities to follow their lead.
Obesity expert likens antiobesity push to anti-smoking fight
In some ways, the nation's efforts to curb obesity can be likened to its more mature push to cut smoking rates, according to obesity expert Dr. Scott Kahan.
Addressing a summit on obesity at Washington, D.C.'s Providence Hospital this spring, Kahan said that just as default conditions in the U.S. today promote unhealthy eating, default conditions in the past promoted smoking. Just as unhealthy food is cheap and easy to access today, cigarettes in the U.S. in the mid-1900s were easily accessible — people could buy them in vending machines — and inexpensive. Just as advertising today pushes and glamorizes unhealthy food, ads of the past did the same for cigarettes. Just as unhealthy eating is not stigmatized today, smoking was generally accepted in the past.
With prodding from the public health community, circumstances that made smoking cheap, easy and popular in the past were changed over time, Kahan said. First, health experts began studying smoking's ill effects and alerting the public to the dangers. In 1964, Surgeon General Luther Terry issued "Smoking and Health: Report of the Advisory Committee to the Surgeon General," a landmark study linking cigarette smoking to disease and premature death. Public sentiment began to turn against smoking as people became more aware of the dangers. Then, legislators at various levels of government began passing legislation to tax or restrict cigarette sales, to limit cigarette advertising, and to restrict where people can smoke. More recently, smoking bans in U.S. localities have prohibited smoking in restaurants, bars and some public places. The U.S. Food and Drug Administration plans to require cigarette companies to print on their labels graphic images of people disfigured or disabled by smoking beginning in September 2012, but a judge with the U.S. District Court in the District of Columbia temporarily blocked that requirement earlier this month.
Some employers have begun to refuse to hire smokers, others charge smokers higher health care insurance premiums.
Kahan said once the social and financial costs of smoking rose, smoking's popularity declined and more smokers determined to quit on their own or with the help of smoking cessation programs. Too, Kahan said. the market has developed ever-better products to help individuals stop smoking, including drugs to reduce nicotine cravings.
Kahan said those engaged in reversing America's obesity epidemic can take cues from those involved in anti-smoking efforts. A key is to make unhealthy choices more difficult and expensive, Kahan said, and to attack the problem on several fronts. On his obesity blog, scottkahan.com, Kahan also says public health efforts, including health education, are critical in the fight against obesity.
Many factors influence weight loss and gain
For most people, losing weight and keeping it off is anything but simple. That is because there are a host of interpersonal and societal factors that influence to what extent people can adapt a healthy lifestyle.
On the societal level, the group that a person associates with may impact his or her acceptance of obesity and willingness to address it. A type of "groupthink" can come into play, according to research published in the journal Obesity. The study found overweight and obese young adults were more likely than their peers who are not overweight or obese to have romantic partners, friends and family members who are overweight.
Family norms and habits also impact people's perspective on obesity and healthy living, according to behavioral science expert Cheryl Kelly, an assistant professor in Saint Louis University's School of Public Health. "You have to consider — a person lives within a context. Children learn at home to develop healthy choices."
Kelly said education is important in the antiobesity effort because even families that are determined to eat better may need to learn about nutrition and how to prepare and store fruits and vegetables.
There is an emotional component to fighting obesity as well, said Kay Beebe, a family nurse practitioner with the medical weight management program at Mercy Health Partners in Muskegon, Mich. When overweight and obese people are depressed, both conditions can be exacerbated.. "People may use food for stress management; they may eat for the wrong reasons — because they're angry or bored for instance."
Another emotional component, Beebe said, is the family dynamics that can come into play when someone is trying to address their own obesity issue. "There can be sabotage," she said. "Not all family members may be ready for a change. Sometimes spouses or kids don't want to eat healthy, for instance."
LaToya Johnson is a Muskegon nursing home employee with two kids. She said she ate when she was stressed or depressed.
When she began seeking help for her obesity through Mercy's weight management program, she wanted to alter the family's traditional Sunday meal, a lavish spread of comfort foods. But she got some pushback from family members who weren't ready for change. In time, as they saw her shedding pounds, they agreed to try healthier recipes and to have less food at the gatherings, she said.
For those who are able to adapt a healthy lifestyle and fight obesity in the short term, there's a danger of "slippage" over the long term, according to Rebecca Blades, the bariatric surgery program leader at Borgess Medical Center in Kalamazoo, Mich. The body compensates for changes in diet and exercise, and becomes more efficient, requiring people to make adjustments to keep up. If they fail to do so, they are likely to regain any weight they may have lost, and maybe even gain more.